Recaidas de la tuberculosis pulmonar. Valor del interrogatorio para la seleccion del esquema terapeutico adecuado
Pulmonary tuberculosis relapses. the value of detailed questioning of the patient for inclusion in an adecuate treatment regime
J.A. Pilheu, M.a C. De Salvo, V. Gnecco, J. Giannattasio, M. Hoffman
Hospital E. Tornú. Buenos Aires
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array:22 [ "pii" => "S0300289615323619" "issn" => "03002896" "doi" => "10.1016/S0300-2896(15)32361-9" "estado" => "S300" "fechaPublicacion" => "1982-05-01" "aid" => "72431" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica" "copyrightAnyo" => "1982" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 1982;18:119-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2037 "formatos" => array:3 [ "EPUB" => 81 "HTML" => 572 "PDF" => 1384 ] ] "itemSiguiente" => array:18 [ "pii" => "S0300289615323620" "issn" => "03002896" "doi" => "10.1016/S0300-2896(15)32362-0" "estado" => "S300" "fechaPublicacion" => "1982-05-01" "aid" => "72432" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 1982;18:124-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1096 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 580 "PDF" => 464 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Seudomesoteliomas: diagnostico diferencial" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "124" "paginaFinal" => "131" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pseudomesotheliomas: a differential diagnosis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Rodriguez Panadero, J.A. Garcia Canton, J. Muñoz Gutierrez, E. Rodriguez Becerra, J. Lopez Mejias" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Rodriguez Panadero" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Garcia Canton" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Muñoz Gutierrez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Rodriguez Becerra" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Lopez Mejias" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615323620?idApp=UINPBA00003Z" "url" => "/03002896/0000001800000003/v1_201509151113/S0300289615323620/v1_201509151113/es/main.assets" ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Recaidas de la tuberculosis pulmonar. Valor del interrogatorio para la seleccion del esquema terapeutico adecuado" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "123" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.A. Pilheu, M.a C. De Salvo, V. Gnecco, J. Giannattasio, M. Hoffman" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Pilheu" ] 1 => array:2 [ "nombre" => "M.a C." "apellidos" => "De Salvo" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Gnecco" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Giannattasio" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Hoffman" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital E. Tornú. Buenos Aires" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary tuberculosis relapses. the value of detailed questioning of the patient for inclusion in an adecuate treatment regime" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1981-10-20" "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="absec0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 200 pacientes con una recaída de su tuberculosis pulmonar y se relacionaron las características de su primer tratamiento con la sensibilidad bacteriana en el momento de la recaída. Fueron clasificados como regulares los pacientes que habían recibido tratamientos asociados, en dosis adecuadas al peso, diario o intermitente, continuo, que lo terminaron espontáneamente (tratamiento incompleto) o por indicación médica (tratamiento completo) e interrumpieron todas las drogas simultáneamente. Se consideraron irregulares a quienes recibieron tratamientos asociados, diarios o intermitentes, completos o incompletos, pero con dosis inadecuadas o con interrupciones o con abandono sucesivo de las drogas. En el grupo desconocido se incluyeron los pacientes en quienes no fue posible obtener datos seguros sobre las drogas recibidas, dosis, duración, forma de abandono. Del total de los 200 pacientes, 146 (73 %) tenían <span class="elsevierStyleItalic">Mycobacteñum tuberculosis</span> sensibles a isoniacida (INH), rifampicina (RAMP), estreptomicina (SM) y ethambutol (EMB), y los 54 restantes (27 %) tenían gérmenes resistentes a una o más drogas. De los 154 regulares, 139 (90,2) presentaban gérmenes sensibles a INH, RAMP, SM y EMB, mientras que de 26 irregulares y 20 desconocidos, sólo dos (7,6 %) y cinco (25 %) pacientes presentaban gérmenes sensibles a las cuatro drogas. La diferencia es estadísticamente significativa (p < 0,001). Entre los pacientes con gérmenes resistentes había 26 (13 %) que lo eran a una sola droga (con franco predominio de la INH), 12 (6 %) a dos drogas, 12 (6 %) a tres drogas y 4 (2 %) a cuatro drogas. La resistencia primaria, estudiada en un grupo de 243 pacientes con tuberculosis pulmonar, no tratados que ingresaron al hospital simultáneamente con los que presentaban recaídas, fue del 7 % (4,5 % a SM, 1,2 % a INH, (1,2 % a SM e INH). La resistencia adquirida (27 %), menos la resistencia primaria (7 %), indicaba la verdadera resistencia debida a la irregularidad de los tratamientos. En el grupo regular, esa diferencia resultó ser 2,7 % (9,7 %- 7), lo que permitía, a los pacientes de este grupo iniciar su tratamiento con un esquema intensivo (con 4 ó 5 drogas) sin esperar el resultado del test de sensibilidad. Aquellos pacientes incluidos en los grupos irregular y desconocido debían, por el contrario, esperar el resultado del test y adecuar el esquema terapéutico al mismo.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los resultados de este estudio sugieren que, a los pacientes con recaída bacteriológica de su tuberculosis pulmonar, un interrogatorio detallado permite su agrupación en regulares, irregulares y desconocidos, y a los del primer grupo se les pueda iniciar un retratamiento con muchas posibilidades de éxito sin esperar el resultado del test de sensibilidad.</p></span>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span id="absec0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The relapses of 200 tuberculous patients were studied and the caracteristics of their first treatment correlated with the bacteriological sensitivity in the relapse. The patients that had received associated treatments, in adecúate dosage to their weight, daily or intermittent, continué, that had finished spontaneously (incomplete treatment) or by medical indication (complete treatment) and had withdrawn all the drugs simultaneously were classified as Regulars. Those who received associate treatments, daily or intermittent, complete or incomplete, but with inadecuate dosage or with interruptions or with succesive abandon of the drugs were considered Irregulars. The patients without positive data about the given drugs, dosage, duration and form of abandon were included in the Unknown group. Out of 200 patients, 146 (73 %) had sensitive <span class="elsevierStyleItalic">Mycybacteterium tuberculosis</span> to isoniazid (INH), rifampicin (RAMP), streptomycin (SM) and ethambutol (EMB) and the remaining 54 patients (27 %) had resistant bacilli to one or more drugas. From the 154 Regulars, 139 (90.2 %) had sensitive germs to INH, RAMP, SM and EMB, while from 26 Irregulars and 20 Unknowns, only 2 (7,6 %) and 5 (25 %) patients presented sensitive bacilli to the 4 drugs. The difference is statistically significant (p < 0,001). Out of 54 patients with resistent germs, 26 (13 %) had resistance to one drug, 12 to two drugs, 12 to three drugs and four to four drugs. The primary resistance, studied in a group of 243 patients with pulmonary tuberculosis, not treated, that arrived to the hospital simultaneously with those who presented relapses, was 7 % (4,5 % to SM, 1,2 % to INH, 1,2 % to SM and INH). The secondary resistance (27 %) minus the primary resistance (7 %) indicated the true resistance due to the irregularity of the treatments. In the Regular group that difference was 2,7 % (9,7 %-7 %), and this permitted the patients from this group to start retreatment with an intensive therapeutic regimen (with 4 or 5 drugs) without waiting the result of the sensitivity test. Those patients included in the Irregular and Unknown groups had on the contrary to wait the result of the tests in order to receive a favorable therapeutic regimen.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The results of this study suggest that the patients with bacteriological relapses of their pulmonary tuberculosis can be classified as Regulars, Irregulars or Unknowns due to their history, and to those of the first group a retreatment can be given, with many possibilities of succes, without waiting the result of the sensitivity test.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical trial of six month and four month regimens of chemotherapy in the treatment of pulmonary tuberculosis" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Singapore Tuberculosis Service/Brit Med Res Counc" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1979.119.4.579" "Revista" => array:6 [ "tituloSerie" => "Amer Rev Resp Dis" "fecha" => "1979" "volumen" => "119" "paginaInicial" => "579" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/375787" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resistencia primaria observada en 974 cepas de Mycobacterium tuberculosis aislados de enfermos pulmonares adultos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Porven" 1 => "R. Piccolo" 2 => "L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 38 | 24 | 62 |
| 2024 September | 33 | 33 | 66 |
| 2024 August | 45 | 36 | 81 |
| 2024 July | 31 | 30 | 61 |
| 2024 June | 40 | 39 | 79 |
| 2024 May | 37 | 43 | 80 |
| 2024 April | 28 | 30 | 58 |
| 2024 March | 34 | 35 | 69 |
| 2024 February | 26 | 35 | 61 |
| 2024 January | 0 | 1 | 1 |
| 2023 December | 0 | 5 | 5 |
| 2023 November | 0 | 10 | 10 |
| 2023 October | 0 | 1 | 1 |
| 2023 August | 0 | 3 | 3 |
| 2023 July | 0 | 13 | 13 |
| 2023 May | 0 | 1 | 1 |
| 2023 March | 11 | 4 | 15 |
| 2023 February | 28 | 22 | 50 |
| 2023 January | 19 | 25 | 44 |
| 2022 December | 27 | 34 | 61 |
| 2022 November | 28 | 22 | 50 |
| 2022 October | 23 | 37 | 60 |
| 2022 September | 17 | 24 | 41 |
| 2022 August | 27 | 43 | 70 |
| 2022 July | 15 | 39 | 54 |
| 2022 June | 23 | 36 | 59 |
| 2022 May | 24 | 32 | 56 |
| 2022 April | 24 | 72 | 96 |
| 2022 March | 30 | 65 | 95 |
| 2022 February | 26 | 24 | 50 |
| 2022 January | 23 | 20 | 43 |
| 2021 December | 9 | 44 | 53 |
| 2021 November | 11 | 53 | 64 |
| 2021 October | 12 | 34 | 46 |
| 2021 September | 12 | 51 | 63 |
| 2021 August | 12 | 31 | 43 |
| 2021 July | 10 | 30 | 40 |
| 2021 June | 13 | 53 | 66 |
| 2021 May | 12 | 42 | 54 |
| 2021 April | 12 | 122 | 134 |
| 2021 March | 43 | 54 | 97 |
| 2021 February | 30 | 31 | 61 |
| 2021 January | 17 | 39 | 56 |
| 2020 December | 19 | 36 | 55 |
| 2020 November | 16 | 47 | 63 |
| 2020 October | 4 | 17 | 21 |
| 2020 September | 10 | 21 | 31 |
| 2020 August | 15 | 41 | 56 |
| 2020 July | 11 | 24 | 35 |
| 2020 June | 12 | 25 | 37 |
| 2020 May | 15 | 38 | 53 |
| 2020 April | 9 | 19 | 28 |
| 2020 March | 11 | 31 | 42 |
| 2020 February | 13 | 43 | 56 |
| 2020 January | 14 | 21 | 35 |
| 2019 December | 17 | 50 | 67 |
| 2019 November | 8 | 21 | 29 |
| 2019 October | 8 | 26 | 34 |
| 2019 September | 7 | 44 | 51 |
| 2019 August | 16 | 26 | 42 |
| 2019 July | 11 | 47 | 58 |
| 2019 June | 9 | 38 | 47 |
| 2019 May | 15 | 40 | 55 |
| 2019 April | 7 | 63 | 70 |
| 2019 March | 3 | 41 | 44 |
| 2019 February | 4 | 15 | 19 |
| 2019 January | 2 | 27 | 29 |
| 2018 December | 7 | 47 | 54 |
| 2018 November | 15 | 26 | 41 |
| 2018 October | 12 | 30 | 42 |
| 2018 September | 10 | 47 | 57 |
| 2018 May | 1 | 3 | 4 |
| 2018 April | 11 | 9 | 20 |
| 2018 March | 6 | 4 | 10 |
| 2018 February | 6 | 15 | 21 |
| 2018 January | 6 | 5 | 11 |
| 2017 December | 4 | 24 | 28 |
| 2017 November | 7 | 43 | 50 |
| 2017 October | 6 | 66 | 72 |
| 2017 September | 8 | 49 | 57 |
| 2017 August | 14 | 88 | 102 |
| 2017 July | 7 | 30 | 37 |
| 2017 June | 11 | 84 | 95 |
| 2017 May | 14 | 33 | 47 |
| 2017 April | 6 | 40 | 46 |
| 2017 March | 5 | 53 | 58 |
| 2017 February | 6 | 35 | 41 |
| 2017 January | 7 | 42 | 49 |
| 2016 December | 20 | 26 | 46 |
| 2016 November | 32 | 17 | 49 |
| 2016 October | 18 | 21 | 39 |
| 2016 September | 18 | 12 | 30 |
| 2016 August | 17 | 6 | 23 |
| 2016 July | 18 | 4 | 22 |
| 2016 June | 25 | 14 | 39 |
| 2016 May | 24 | 4 | 28 |
| 2016 April | 31 | 0 | 31 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 11 | 2 | 13 |
| 2016 January | 8 | 5 | 13 |
| 2015 December | 20 | 10 | 30 |
| 2015 November | 25 | 7 | 32 |
| 2015 October | 4 | 1 | 5 |
| 2015 September | 1 | 0 | 1 |
Show all
